Magnaretractor system and method

ABSTRACT

A system and method for performing surgical procedures within a body cavity, e.g. abdomen, uses a magnetized device is utilized to allow a surgeon to control intra-abdominal organs and objects. The system and method allows a surgeon to perform an intra-abdominal procedure without the need to position surgical tools inside of the body cavity. Additional surgical ports are not necessary as the magnetized device allows the surgeon to retract or position various objects within the abdomen.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a Continuation of U.S. patent application Ser. No.14/918,974, filed Oct. 21, 2015, now U.S. Pat. No. 9,962,148, which is aContinuation of U.S. patent application Ser. No. 14/074,783, filed Nov.8, 2013, now U.S. Pat. No. 9,386,973, which is a Continuation of U.S.patent application Ser. No. 12/787,998, filed May 26, 2010, now U.S.Pat. No. 8,602,981, which is a Continuation-in-Part of InternationalApplication PCT/US08/84991, filed Nov. 26, 2008, which claims thebenefit of U.S. Provisional Application 60/996,575, filed Nov. 26, 2007,the contents of which are incorporated by reference herein.

FIELD OF INVENTION

The present invention is directed generally to surgical apparatus,systems and methods for use in subjects including humans and animals,and to apparatus, systems and methods of manipulating objects within thebody of a subject when performing laparoscopy.

BACKGROUND OF INVENTION

When performing laparoscopic surgery in a body cavity such as theabdomen, the number of surgical instruments which can be manipulated inthe abdomen is limited by the number of abdominal ports incised.Accordingly, the number of organs and tissues the surgeon can manipulatesimultaneously is limited by the number of instruments in place.

In a standard laparoscopy for endometriosis, for example, a camera isplaced through the umbilical port, and two lower quadrant ports are madefor use with instruments. In order to access, excise or fulgurateendometriosis deep in the pelvis or behind an ovary, the ovary must beretracted. An instrument is inserted into one port and used for thepurpose of grasping and retracting the ovary. It is often difficult tocontrol the ovary with the grasper, often resulting in unwanted anduncontrolled movement of the ovary. With the camera inserted through theumbilical port and the grasper inserted through a second port, there isonly one port left available to the surgeon. Since there is only oneport available, the process of fulgurating or excising the endometrialimplants is thereby made more difficult, because in order to avoiddamaging the underlying tissues, the peritoneum must be tented up. Thesurgeon must tent the peritoneum and fulgurate or excise the endometrialimplants with a single instrument, or alternatively, incise one or moreadditional ports. The addition of operating instruments then willrequire the surgeon to relinquish control of the grasper since only twoinstruments can be manipulated at one time.

However, additional ports and instruments are not desirable for manyreasons. Every additional port requires an accompanying abdominalincision, which pierces the peritoneum and abdominal muscles, andincreases the risk of striking a blood vessel and infection.Furthermore, each incision carries cosmetic implications for thepatient, as a visible scar may be formed.

In addition to the problem of adding ports to allow additionalinstruments into the abdominal cavity, there is a problem of limitedworkspace within the abdominal cavity. As more instruments areintroduced into the abdomen, the area can become congested. With thiscongestion, instruments may inadvertently block or bump into each other,making the procedure more difficult for the surgeon and increasing therisk for the patient.

For example, in a laparoscopic hysterectomy, it is often difficult toretract the uterus in the beneficial manner possible in an openabdominal hysterectomy. In an open abdominal hysterectomy, a cork screwtool is often placed in the fundus of the uterus and used for upwardtraction in order to decrease bleeding. The traction on the uterus alsomakes it easier to access the lateral sides of the uterus and suture andligate the uterine arteries and cardinal ligaments. To do thislaparoscopically, the surgeon must try and place an extra port and use agrasper to retract the uterus—often a very difficult task. Additionally,the extra grasper often causes instrument clutter with the otherinstruments being used to carry out the dissection.

Furthermore, the surgeon is physically limited to controlling twoinstruments at a time, i.e., one instrument per hand. If it is electedto use an additional instrument to perform a function such as retractionof an ovary or manipulation of the uterus, the surgeon will encounterthe problem of not being able to manipulate all of the instrumentssimultaneously.

In light of these problems, it would be desirable to have a laparoscopicsystem whereby a surgeon might retract and manipulate intra-abdominalorgans and objects without the necessity of placing extra ports, as wellas having the ability to gain better control over organs and performfunctions currently not possible laparoscopically. It would also bedesirable to have a system whereby a surgeon might manipulateintra-abdominal organs and objects without the added congestion of theabdominal cavity associated with the introduction of additionalintra-abdominal instruments.

SUMMARY OF THE INVENTION

The present invention is a laparoscopic surgical method and system usingmagnetic fields such as those produced by magnets and tools responsiveto these magnetic fields to allow a surgeon to retract and controlintra-abdominal organs and objects without the necessity of having toplace additional items in the abdominal cavity.

The system uses various fasteners such as screws, loops, clips, clampsetc., to attach to objects and organs within the body. These fastenersare capable of being influenced or manipulated in three-dimensionalspace, directly or indirectly, by a magnetic or electromagnetic field,to allow the surgeon to control intra-abdominal organs and objectswithout placing additional abdominal ports. The fasteners are thendetached from the long tool used to place them into the abdomen. Then,an apparatus containing a magnetic field source, such as a magnet orelectromagnet, is placed on the outside of the abdomen. The magneticfield produced by this apparatus is used to manipulate the fastenersattached to the objects or organs inside the abdomen, allowing thesurgeon to retract or position the object around the abdomen without theuse of an intra-abdominal instrument or placing additional ports.

BRIEF DESCRIPTION OF THE DRAWINGS

The present invention will be understood and appreciated more fully fromthe following detailed description, taken in conjunction with thedrawings in which:

FIG. 1 is an embodiment of an intracorporeal, extracorporeal andplacement apparatuses;

FIG. 2A is an embodiment of an intracorporeal apparatus;

FIG. 2B is an embodiment of a magnetically responsive portion of anintracorporeal apparatus;

FIG. 2C is an embodiment of an intracorporeal apparatus, wherein thedesign provides for reuse of magnetic material;

FIG. 2D is an alternative embodiment of an intracorporeal apparatus witha screw mechanism, for conversion into rotational energy;

FIG. 2E is alternative embodiment of an intracorporeal apparatus with aloop mechanism for placement of objects;

FIG. 2F is an alternative embodiment of an intracorporeal with a largeloop mechanism;

FIG. 3A is a detailed embodiment of a placement apparatus;

FIG. 3B is an embodiment of a placement apparatus engaging anintracorporeal apparatus;

FIG. 3C is an alternative embodiment of a placement apparatus utilizingmagnetic energy;

FIG. 3D is an alternative embodiment of a placement apparatus utilizingelectromagnetic energy;

FIG. 3E is an alternative embodiment of a placement apparatus attachedto an electromagnetic energy source;

FIG. 3F is an alternative embodiment of a placement apparatus with aninterface to generate rotational energy;

FIG. 3G is an alternative embodiment of a placement apparatus, whereinpermanent magnets used in the device may be placed in a resealablechamber;

FIG. 3H is a topical view of a connector engaged with an intracorporealapparatus;

FIG. 4A is an embodiment of a magnetically energized extracorporealapparatus;

FIG. 4B is an alternative embodiment of an extracorporeal apparatuscontaining a movable magnet mechanism;

FIG. 4C is an alternative embodiment of an extracorporeal apparatusutilizing electromagnetic energy; and

FIG. 4D is an alternative embodiment of an adhesively anchoredextracorporeal apparatus;

FIG. 5 is an alternative embodiment of an intracorporeal and placementapparatuses.

DETAILED DESCRIPTION OF THE INVENTION

The present invention provides laparoscopic surgeons a system and methodto allow the surgeon to retract and manipulate intra-abdominal organsand objects without placing extra ports. Furthermore, the presentinvention allows the surgeon to maintain increased control over hisinstruments due to increased space in the body cavity.

In a preferred embodiment, the system of the invention performs itsfunctions with three classes of magnaretractor apparatuses workingtogether—the intracorporeal apparatus 1, extracorporeal apparatus 2, andplacement apparatus 3. See FIG. 1

The intracorporeal apparatuses are the set of tools that are used toattach to an object or tissue inside a patient's body. They are designedto interact with the placement apparatus to place it in the correctposition inside the body, an extracorporeal apparatus to manipulate itfrom outside the body, and the object or tissue the surgeon wishes tomanipulate. FIG. 2A shows a preferred embodiment of an intracorporealapparatus. The preferred embodiment comprises a body 100 of some shapesuch as a narrow shaft at least in one cross section having a size nogreater than a trocar. This is necessary as the intracorporeal apparatusin its preferred method of use will be passed through a trocar port intothe patient's body. At one end 102 of the intracorporeal apparatus body,the apparatus is adapted to attach to an object or tissue. At theopposing end 104 of the body, the apparatus is adapted to engage with aplacement apparatus.

The intracorporeal apparatuses are designed to both physically engagethe placement apparatus, and respond to energy from an extracorporealapparatus. A preferred embodiment accomplishes this by using magnets 120disposed in one end 104 of the intracorporeal apparatus opposite thefastener end 414. To aid in engaging a placement apparatus, the magnetattracts an end of the placement apparatus containing a materialattracted to the magnet. When the end of the placement apparatus isdrawn near the end of the intracorporeal apparatus containing themagnet, the two apparatuses are attracted. If there is no impedingmaterial located between the placement and intracorporeal apparatuses,the two apparatuses will contact and stick to each other, end to end.Advantageously, the magnetic end 104 of the intracorporeal apparatus isrounded to align axially with the placement apparatus. This alignment isimperative to allow the surgeon to retract both the placement andintracorporeal apparatuses through the trocar as well as to allow theinterfaces of the placement apparatus to correctly engage the matingnodes of the intracorporeal apparatus. To further aid engaging andaligning the intracorporeal apparatus to the placement apparatus,grooves or ridges 108 are placed on the end 104 of the intracorporealapparatus to match the grooves or ridges 108 placed on the end of theplacement apparatus. When the two apparatuses are pulled proximate toeach other by their magnetic attraction, the grooves and ridges forcethe two apparatuses to align with the end of the placement apparatusslightly overlapping the end of the intracorporeal apparatus, andforming a tight connection.

In a similar alternative embodiment shown in FIG. 2B, a portion of thebody 100 of the intracorporeal apparatus is made of a materialresponsive to magnetic energy, and the magnet is instead disposed in theend of the placement apparatus. With this embodiment, the magnet on theplacement apparatus may be a permanent magnet or an electromagnet. Thefunction performed by this reversed embodiment is identical to thefunction as described above.

As with all medical devices, sterilization is a key consideration.Typically, sterilization of medical equipment is performed using anautoclave, which amongst other things, heats the equipment to atemperature higher than any germ can withstand to kill any germspresent. Unfortunately, some embodiments of the present inventionutilize permanent magnets, which when heated near a certain temperatureknown as the Curie temperature, will permanently lose their magnetism.Therefore, special consideration in design and use must be made toensure that the tools are both sterile and properly magnetized. Thesimplest procedure to ensure correct magnetization is to use a newdevice with a fresh magnet for each surgery. Alternatively, magnets maybe employed having Curie temperatures well in excess of sterilizationtemperatures. Other embodiments of the invention are designed toaccommodate reuse.

One such embodiment of the intracorporeal apparatus is shown in FIG. 2Cand is designed to permit reusing the magnet, but allowing the choice ofdisposing the rest. In this embodiment, the body 100 is at leastpartially covered by a sterile plastic shell. The body 100 has aresealable chamber 140 proximate the end 104 which engages the placementapparatus, wherein the permanent magnet 120 is placed. In the preferredembodiment, the chamber is formed by a cap 142 over a hollows 146 in thebody wherein the cap screws or presses into the rim 144 of the hollows.After a surgery, the surgical team can remove the magnet 120 from theintracorporeal apparatus, and determine whether to sterilize the rest ofthe apparatus or discard it. If the team chooses to sterilize its usedintracorporeal apparatuses, after sterilization, the team may place anavailable magnet back into the resealable chamber 140 of the now sterileapparatus. The team may also choose to use an unused sterileintracorporeal apparatus, in which case they may place an availablemagnet into its resealable chamber 140 and reseal the chamber, preparingit for surgery. In either method, the magnet is removed after surgery,and thus never exposed to the destructive heat of an autoclave.

Another embodiment of the intracorporeal apparatus is designed aroundreusing the entire apparatus. In this embodiment, the body 100 is madeof a magnetically inert metal. Like the previous embodiment, the body ofthe intracorporeal apparatus has a resealable chamber 140 proximate theend 104 to house a permanent magnet. Similarly, in the preferredembodiment, the resealable chamber 140 is formed by a metal 142 cap overa hollows 146 in the body wherein the cap screws or presses into the rim144 of the hollows 146. After a surgery, the surgical team can removethe magnet 120 from the intracorporeal apparatus, and then sterilizethis embodiment of the apparatus in an autoclave. To prepare for asurgery, the surgical team may use either an unused intracorporealapparatus or an intracorporeal apparatus that has been autoclaved,perfecting preparation for surgery by placing an available magnet intothe resealable chamber 140 and resealing the chamber. Using thisembodiment and method, because the magnet was removed after surgery, itis never exposed to the destructive heat of an autoclave.

Known methods of sterilization not involving heating may, of course, beconveniently employed to sterilize the apparatus of the invention.

This structure forms the platform for nearly limitless types ofattachments and fasteners to be constructed for the surgeon's use. Suchconceived attachments include screws, loops, clips, clamps, and thelike. A screw may be useful for piercing and driving into a thick ormuscular organ, such as a uterus, to gain appropriate traction tooperate. The screw embodiment of the intracorporeal apparatus shown inFIG. 2D may have a port 106 on its end 104 to receive a type of energyand convert it into rotational energy. The surgeon using this embodimentmay use the rotation of the screw 210 to drive the intracorporealapparatus into the tissue which it is desired to manipulate.

In a preferred embodiment of the screw intracorporeal apparatus, amatching placement apparatus 3 has an interface such as a rotatable knob220 on the portion of the placement apparatus that remains outside thepatient's body. Twisting the knob 220 manipulates a shaft 230 whichconnects to a node 240 at the end of the placement apparatus. This nodeengages a second mating node 250 on the screw intracorporeal apparatus.The second node 250 is in turn mechanically connected to the screw 210by an axle 260, which is adapted to rotate independently from the body100. Therefore, twisting the knob 220 on the placement apparatus rotatesthe screw 210 on the intracorporeal apparatus. The length of the screw210 may be varied in order to obtain the optimal distance between thebody part which it is desired to manipulate and the abdominal wall.Another embodiment includes a non-human powered drive in the placementapparatus to drive the shaft 230 and cause the screw 210 to rotate at ahigher power than a human can exert without strain.

Another embodiment of an intracorporeal apparatus, shown in FIGS. 2E and2F is in the form of a loop. The loop embodiment may be used to attachto an object by placing the loop around the object, tightening the loopand capturing the object. The loop can later be loosened to release theobject when finished.

In a preferred embodiment of the loop intracorporeal apparatus, amatching placement apparatus 3 has an interface such as a lever, button,or trigger 320 on the portion of the body that remains outside thepatient's body. This trigger 320 drives a shaft 330 which connects to anode 340 at the first end of the body. This node engages a second matingnode 350 on the loop intracorporeal apparatus. This node 350 is in turnmechanically connected to one or both ends of the loop 300 such that asthe node 350 moves towards the loop, the loop opens, and as the nodemoves away from the loop, the loop closes. Therefore, the loop opens andcloses in response to the surgeon moving the trigger 320 on theplacement apparatus outside the patient's body.

An additional feature is a locking mechanism which maintains thetightened loop when the intracorporeal apparatus is not engaged with aplacement apparatus. The mating node 350 on the intracorporeal apparatusis tensioned with a spring 360. This spring pushes the mating node awayfrom the loop, thus holding the loop closed. However, when engaged witha placement apparatus, the surgeon's pressure on the trigger 320 caneasily overcome the spring, forcing the loop to open.

Inside the intracorporeal apparatus, the loop 300 is actuated by movingpulleys 310 and stationary pulleys 315. Moving pulleys 310 are mountedon a piston 130. The loop 300 is threaded between moving pulleys 310 andstationary pulleys 315 as shown in FIG. 2E. When the mating node 350 ispushed towards the loop, piston 130 and moving pulleys 310 advancetoward the stationary pulleys 315. As shown in FIG. 2F, this shortensthe internal path loop 300 must take within body 100, allowing more ofthe loop to extend outside body 100. When the mating node 350 is pushedtowards the end 104, piston 130 and moving pulleys 310 return back totheir extended position as shown in FIG. 2E. As shown in FIG. 2E, thislengthens the internal path loop 300 must take within body 100, causingless of the loop to extend outside the body 100. When force is removedfrom mating node 350, spring 360 causes piston 130 and mating pulleys310 to return to this long-path state.

A third embodiment of the intracorporeal apparatus is a clip mechanism.The clip embodiment can be used to attach a surgical clip to an objectproximate the end of the clip intracorporeal apparatus while retractingthe object, and leaving the clip in place. In a preferred embodiment ofthe clip intracorporeal apparatus, a matching placement apparatus has aninterface such as a lever, button, trigger on the portion of theapparatus that remains outside the patient's body. This trigger drives ashaft which connects to a node at the end of the apparatus. This nodeengages a second mating node on the clip intracorporeal apparatus. Thesecond node is in turn mechanically connected by a piston 130 such thatas the node moves toward the clip, the clip is expelled from the clipintracorporeal apparatus and closes permanently on the object.Therefore, the clip is closed about an object in response to the surgeonmoving the trigger on the placement apparatus outside the patient'sbody.

In an alternative embodiment shown in FIG. 5, the placement apparatus500 may have an interface in the form of a scissor-like mechanism 510.An additional feature is a locking mechanism 520 that maintains theplacement apparatus' lever, button, trigger, or scissor-like mechanismin a position set by the user. The locking mechanism 510 prevents theshaft from moving once the user supplied force has positioned the shaft.This allows the surgeon to maintain an intracorporeal apparatus engagedwith a placement apparatus in a position when trying to attach theintracorporeal apparatus to a patient's body.

A fourth embodiment of the intracorporeal apparatus is a clamp. Theclamp embodiment can be used to form a simple attachment to an objectwhereby the surgeon opens the clamp and closes it around an object, tomaintain its position. The clamp can later be opened to release theobject.

In a preferred embodiment of the clamp intracorporeal apparatus, shownin FIG. 2A, a matching placement apparatus 3 has an interface such as alever, button, or trigger 420 on the portion of the apparatus thatremains outside the patient's body. This trigger 420 manipulates a shaft430 which connects to a node 440 at the end of the apparatus. This node440 engages a second mating node 450 on the clamp intracorporealapparatus. The second node 450 is in turn mechanically connected by apiston 130 to one or both sides of the clamp 410 such that as the node450 moves towards the clamp, the clamp opens, and as the node moves awayfrom the clamp, the clamp closes. Therefore, the clamp opens and closesin response to the surgeon moving the trigger 420 on the placementapparatus outside the patient's body. An additional feature is thelocking mechanism which holds the clamp tight when the intracorporealapparatus is not engaged with a placement apparatus. The mating node 450on the intracorporeal apparatus is spring tensioned by use of the clamp410. The clamp is preferably constructed of a single rigid material thatwhen at rest will close down its tines 414 to a point. For additionalgrip, the teeth 418 may be disposed near the end of one or both tines414. The tines are connected to each other by a flexible filament 416which is thread through the body 100 across pulleys 418. The piston 130is in physical contact with the filament 416 inside the body 100. Thespring function of the tines 414 keeps the filament 416 in a tautposition. This taut filament 416 pushes against the piston 130 away fromthe clamp. However, when engaged with a placement apparatus, thesurgeon's pressure on trigger 420 can easily overcome the tension placedon the filaments by the tines 414. This pressure forces mating node 450and piston 130 to move towards the clamp 410, stretching filament 416.As pressure is applied to the filament 416, the tines 414 are forced toopen.

The placement apparatuses are the tools that are used to physicallyposition the intracorporeal apparatuses inside the patient's body andcause them to attach to objects. The preferred embodiment, shown inFIGS. 3A and 3B, comprises a body 500 having some shape with some lengthat least in one cross section having a size no greater than a trocarbeing of a length which would allow it to access distant areas withinthe body and allow the surgeon to comfortably operate the portion of theapparatus remaining outside the patient's body.

The preferred embodiment further comprises a connector 502 disposed onthe end of the body that is placed through the trocar into the patient'sbody. This connector is adapted to engage and disengage any of numerousintracorporeal apparatuses 1. The connector is controlled by anengagement interface near the end of the body that remains outside thebody during surgery. This engagement interface can be a button, anelectrical connection to an external device or, most preferably, anengagement lever 504 that slides in the direction along the body'slength, and is mechanically attached by a shaft 506 to the connector 502at the far end of the body 500. When the engagement lever 504 is movedcloser to the far end, the connector 502 moves with the engagement leverto capture and engage with an intracorporeal apparatus 1. When the leveris moved away from the far end, the connector moves with the lever todisengage and release an intracorporeal apparatus.

The preferred embodiment also comprises another interface near the endof the body that remains outside of the patient's body. This actioninterface transmits mechanical energy from the surgeon or another sourceoutside the body to an intracorporeal apparatus if engaged to theplacement apparatus. The preferred embodiment for the action interfaceis a lever in the form of a trigger 510 which is spring loaded. Thetrigger 510 is mechanically connected to a node 514 at the far end ofthe body 500 by a shaft 512. This node 514 engages with a mating node 50on an intracorporeal apparatus 1, the intracorporeal apparatus then inturn converts the delivered energy for its uses. The action interfacemay also be alternatively an electrical connection to an externaldevice.

In order to assist engaging with the preferred embodiment of theintracorporeal apparatus described above, the placement apparatus musthave some magnetically responsive material to attract the permanentmagnet in the intracorporeal apparatus. The preferred embodiment thushas a mass of magnetically responsive material 525 disposed within thebody 500 of the placement apparatus near the end that enters thepatient's body. This magnetically responsive material 525 ismechanically connected to the connector 502 and moves toward the endwhen the engagement interface is moved towards the end. The magneticallyresponsive material 525 moves away from the end further up the body 500when the engagement interface is moved away from the end. As a result,when the engagement interface is positioned to engage an intracorporealapparatus, the magnetically responsive material is most proximate theend of the body, and thus more easily attracted to the magnet in theintracorporeal apparatus. Furthermore, when the engagement interface ispositioned to disengage from the intracorporeal apparatus, themagnetically responsive material is pulled away and outside theattractive reach of the intracorporeal apparatus magnet, thus allowingthe two apparatuses to separate.

It will be appreciated that any magnetically responsive material may beutilized in accordance with the teaching of the invention. Presentlypreferred magnetically responsive material includes ferrous oriron-containing material, rare-earth containing materials, and the like.Exemplary magnetic materials are listed in Table 1.

In another embodiment, shown in FIGS. 3C and 3D, the placement apparatuscontains a magnet 530 or electromagnet 540 disposed near the end of thebody that enters the patient's body. The magnet 530 attracts themagnetically responsive material in certain embodiments of theintracorporeal apparatuses, performing the same function in aiding thesurgeon to engage the intracorporeal apparatus inside the patient'sbody. Similarly to the preferred embodiment, this magnet 530 may bedisposed within the shaft of the body 500 and mechanically connected tothe connector 502. In this way, the magnet 530 moves closer to the endof the body 500 when the engagement interface is slid towards the end.With the magnet closer to the end, the placement apparatus will moreeasily attract the intracorporeal apparatus. Similarly, the magnet movesinto the interior of the body and further from the end as the engagementinterface is slid away from the end. With the magnet further from theend, the intracorporeal apparatus will be less attracted to theplacement apparatus, which will cause an easy separation.

In the case of using an electromagnet 540, the system can take advantageof controlled temporary magnetism. To engage an intracorporeal apparatus1, the electromagnet 540 is turned on, and so attracts the magneticallyresponsive material 120 in a corresponding intracorporeal apparatus.Similarly, to disengage the intracorporeal apparatus, the electromagnet540 is turned off. With slight movement from the surgeon, theintracorporeal apparatus will no longer be attracted to the placementapparatus, and the two apparatuses may be separated. To power theelectromagnet, a detachable power supply connects to the placementapparatus near the end that remains outside the patient's body. Thispower supply being external to the placement apparatus allows theplacement apparatus to be made smaller. Furthermore, because it isdetachable, the surgical team may detach the power supply and sterilizethe placement apparatus in an autoclave as they normally would. Whensterile, the team may then reattach the power supply for use in asubsequent procedure.

A preferred embodiment also comprises a third interface near the end ofthe body that remains outside of the patient's body. The interface 550when activated by the surgeon causes the connector 502 and any objectengaged to it to rotate about the axis of the placement apparatus.Utilizing this embodiment, the surgeon's interface 550 may articulate anintracorporeal apparatus 1 attached to the placement apparatus in afashion similar to the manner in which surgeons currently rotatelaparoscopic instruments within a patient's body.

In embodiments of the placement apparatus containing their own permanentmagnets, a similar situation arises as seen in the intracorporealapparatuses above involving sterilization. Typical sterilization in anautoclave may strip the permanent magnets of their magnetism. To preventthis in embodiments with permanent magnets, such as shown in FIG. 3G,the magnet 530 may be placed in a resealable chamber 560 proximate theend of the body 500 that is passed into the patient's body. In apreferred embodiment, the resealable chamber is formed by a cap 562 overa hollow in the body wherein the cap presses into the rim of thehollows. After a surgery, the surgical team can remove the magnet 530from the placement apparatus, and sterilize the remainder in anautoclave. In preparation for a subsequent surgery, the team may take anunused or an autoclaved placement apparatus, place an available magnetinto its resealable chamber, and replace the cap on the chamber, therebyrendering the placement apparatus ready for utilization in a subsequentsurgery.

FIG. 3H demonstrates a top view of the connector and its interactionwith the intracorporeal apparatus. To further aid the engagement andalignment of the intracorporeal apparatus to the placement apparatus,grooves or ridges 108 are placed on the end of the intracorporealapparatus to match grooves or ridges 508 on the connector 502. When thetwo apparatuses are pulled proximate to each other by their magneticattraction, the grooves and/or ridges 108 force the intracorporealapparatus to align with the grooves and ridges 508 on the connector 502slightly overlapping the end of the intracorporeal apparatus, andforming a tight connection. Additionally, the placement apparatus may befitted with a moveable or flexible tab 509 mechanically connected to theengagement interface. This tab 509 is adapted to fit within a groove 109on an intracorporeal apparatus in a mating fashion when the engagementinterface is moved toward the end of the body. Thus, the tab thus locksthe intracorporeal apparatus to the placement apparatus.

A third major component of this system is the extracorporeal apparatus.This apparatus may be used to position an intracorporeal apparatus andany object attached to it within the patient's body. Preferredembodiments of this apparatus comprise a body of some shape with anaffixed handle and preferably a magnet or other source of magneticenergy. The extracorporeal apparatuses require a magnetic field sourcethat can produce a magnetic field sufficient to manipulate objectsfastened to an intracorporeal apparatus.

In the preferred embodiment shown in FIG. 4A, the extracorporealapparatus may be shaped like a disk with the magnet 610 contained in themiddle of the body 600, away from the surface. In this embodiment, thebody forms a shell around the magnet, comprised of either a medicallyinert plastic or a magnetically inert metal or a combination of bothmaterials. Both materials are suitable to prevent the magnet from comingin direct contact with the patient's body, but also serve the purpose ofprotecting the magnet. Many types of magnets used in the preferredembodiments are so fragile or brittle, that their own attraction toanother magnet can cause the magnet to disintegrate upon contact. Inorder to preserve the magnet within, the body surrounding the magnetabsorbs some of the energy in the event of an impact with a hard surfaceor a corresponding magnaretractor apparatus.

For sterilization purposes, the extracorporeal apparatus may bepartially wrapped by a disposable or sterilizable cover 620. As with theplacement and intracorporeal apparatuses, the use of permanent magnetspresents a situation wherein the typical method of sterilization, i.e.,use of an autoclave may destroy the magnetic properties of the magnet.After use in surgery, the surgical team may remove this cover from theextracorporeal apparatus, and either discard or sterilize it for lateruse. In preparation for a subsequent surgery, the team then may simplyplace a new or sterilized cover on an available extracorporealapparatus. In order to ensure that the sterile cover does not separatefrom the extracorporeal apparatus during surgery, it is preferred thatthe cover comprise a form-fitting boot to frictionally adhere to thebody of the extracorporeal apparatus.

An additional method to ensure the extracorporeal apparatus is sterilefor a subsequent surgery is to use an extracorporeal apparatusembodiment having a resealable magnet chamber. In this embodiment, theresealable chamber 640 resides in the central area of the apparatus body600. In the preferred embodiment, the chamber is formed by a cap 642over a hollows in the body wherein the cap screws or presses into therim of the hollows. After a surgery, the surgical team can remove themagnet 610 from the extracorporeal apparatus 2, and determine whether tosterilize the apparatus or discard it. If the team chooses to sterilizeits used extracorporeal apparatuses, after sterilization, the team mayplace an available magnet back into the resealable chamber 640 of thenow sterile apparatus. The team may also choose to use an unused sterileextracorporeal apparatus, in which case they may place an availablemagnet into its resealable chamber in preparation for surgery. In eithermethod, the magnet is never exposed to the destructive heat of anautoclave.

In all of the above embodiments including a permanent magnet, there aremany choices of magnets available with varying benefits and detrimentsto each of their respective uses. The magnets of the extracorporealapparatuses must be strong enough to exert sufficient pulling (orpushing) force to permit manipulation of the desired object within thebody cavity from a distance of several centimeters. For example, inperforming a hysterectomy on a fibroid uterus, the magnet pulling anattached intracorporeal apparatus must reach through as much as 5centimeters or even more of the patient's body to cause the uterus tomove.

While this situation suggests the use of a larger, more powerful magnet,other considerations require the magnet to be as weak as possiblewithout disrupting function. For instance, it is very likely that thesurgeon will place more than one intracorporeal apparatus inside thepatient's body. An extremely strong magnet may disadvantageously attractboth the intended and an unintended intracorporeal apparatus, as well asany other objects containing magnetically responsive material in theroom. Furthermore, such a strong magnet will also be physically largerthan necessary to perform the procedure, thereby rendering it toounwieldy to control or anchor. A third consideration is that a verystrong magnet will apply a considerable force to an object attracted toit, which may pinch tissue between the object and the magnet, withenough force to cause damage to the patient.

Accordingly, the present invention includes a set of extracorporealapparatuses with magnets of varying sizes, shapes and materials, or anadjustable electromagnet. The first consideration for a surgical team inchoosing which type of magnets to use concerns whether they will reusethe tools, and if so, how they will sterilize them. A surgical teamchoosing to discard used extracorporeal apparatuses is only limited inits choice by the expense of individual magnets, and therefore needsonly consider the magnetic strength required for this particular patientor procedure.

Surgical teams that choose to reuse however must consider the Curietemperature for the magnet they wish to use, and a particularsterilization method. As mentioned above, using an autoclave may destroya magnet's magnetism. Therefore, the team has three options for reuse.The first option is to choose a magnet with a Curie temperature muchhigher than their autoclave can generate, such as Samarium-cobalt orAlnico magnets. With this option, the team may simply place the entireapparatus into the autoclave as they would any other equipment. For manypurposes, this may be an adequate solution. However, bothSamarium-cobalt and Alnico magnets are weaker than Neodymium magnets,and such strength may be necessary for patients with thick adiposetissue or in procedures that require manipulation of deeply situated orheavy objects.

The second option is to choose an extracorporeal apparatus having aremovable magnet in a resealable chamber. With this option, the teamremoves the magnet from the apparatus after use. The apparatus then maybe placed in the autoclave as the team typically would to sterilizeequipment. After sterilization, the team would then place the magnetback into the apparatus prior to conducting another surgery. There is nolimitation to the team placing the magnet in the same apparatus, as themagnet may be placed in any available apparatuses. This option will workwell in any situation, however the surgical team must take the necessaryprecautions.

The final option is to use permanently positioned magnets within theapparatus. After use, the surgical team may place the entireextracorporeal apparatus into the autoclave, without regard to Curietemperatures until sterilization is achieved. Since the magnet embeddedin the apparatus may have been demagnetized, before use, the team mustplace the apparatus into a remagnetizer to return the magnet to its fullmagnetic capabilities. The team may perform this on-site, or return theapparatus to an appropriate vendor who can perform a remagnetizingservice to re-magnetize the magnets. A preferred embodiment of aremagnetizer includes a body which physically mates with theextracorporeal apparatus to hold it in one position during there-magnetization process. The remagnetizer exposes the magnet within themagnaretractor apparatus to a high-intensity magnetic field, whichcauses the magnet to retain its original magnetic field. This option maysimilarly be used to sterilize and re-magnetize intracorporeal andplacement apparatuses.

TABLE 1 Exemplary magnets and their characteristics Curie Material Temp.Characteristics Cobalt (Co) 1115° C.  Very high Curie temp. Low strengthAlnico 800° C. High Curie temp. Much weaker than SmCo and NIB magnetsMuch stronger than other non-rare earth magnets Iron (Fe) 770° C. HighCurie temp. Low strength Samarium- 680 to High Curie temp. cobalt 800°C. Very high strength (SmCo) More expensive than NIB magnets Weaker thanNIB magnets Very brittle Nickel (Ni) 354° C. Low strength Low Curietemp. Neodymium 320° C. Strongest permanent magnet (NdFeB or currentlysold commercially NIB) Less expensive than SmCo magnets Low Curietemperature Brittle but less so than SmCo Highly corrosive

While the size and material of the magnet determines its strength, theshape has an effect on how much the magnetic field “falls off” overdistance. For example, a magnet shaped like a long rod may be strongenough to cause an object weighing 1 kilogram from one centimeter awayto accelerate towards the magnet. This same magnet can only cause thesame acceleration on an object weighing 250 grams from two centimetersaway or 40 grams from five centimeters away. In this situation, thestrength of the magnetic field is said to fall off with the square ofthe distance, giving this magnet a deep reach. Although a magnet havinga different shape may also be able to cause an object weighing 1kilogram from one centimeter away to accelerate towards it, however, attwo centimeters, it may only have the capacity to cause the sameacceleration on an object weighing 125 grams, and from five centimetersthe magnet may only cause the same acceleration on an object weighing 8grams. In this situation, the strength of the magnetic field is said tofall off with the cube of the distance, i.e., a shallower reach. Thus,the surgeon will have the option of choosing an extracorporeal apparatuswith a deeper or shallower reach.

During surgery, the surgeon may use special trocars with graduations tomeasure the thickness of the abdominal walls of the patient's body. Withthat measurement and the surgeon's knowledge of the approximate weightof the object to be moved, the surgeon may choose the appropriateextracorporeal apparatus having a magnet of the required strengthamongst the plurality of available apparatuses.

The extracorporeal apparatus may be fine tuned by disposing the magneton an articulable joint. In this embodiment, preferably utilizing a cupshape as shown in FIG. 4B, the magnet 610 may be moved closer or furtheraway from the patient's body by manipulating the articulable joint 660.This way, the surgeon may exact greater or lesser force on an objectheld by an intracorporeal apparatus within the body. Additionally, thesurgeon may use intracorporeal apparatuses containing its own magnets,which will interact with the magnet 610 in the extracorporeal apparatus2. Using the articulable joint 660, the surgeon may rotate the magnet ofthe extracorporeal apparatus 600, which would cause the magnet of thenearby intracorporeal apparatus to rotate in sympathy. The result isthat the surgeon can manipulate the attitude of the object within thepatient's body by articulating the magnet attached to the extracorporealapparatus.

Another embodiment shown in FIG. 4C uses an electromagnet 615 as thesource of magnetic energy. In this embodiment, the strength of theelectromagnet's 615 magnetic field is adjustable to allow the surgeon tochoose the smallest field required to position a single intracorporealapparatus, and not interfere with other apparatuses or othermagnetically responsive objects. A detachable power supply cable 617provides power to the electromagnet 615.

To ease using the extracorporeal apparatus, the surgeon may lubricatethe surface 670 touching the patient's body to allow it to move moreeasily, and anchor the apparatus to the body, the surgical drape, thesurgical table, or another fixed object, to prevent the apparatus frommoving once in place.

Anchoring the extracorporeal apparatus in a fixed position may also beaccomplished by using an air pump. The preferred embodiments shown inFIGS. 4A, 4B and 4C dispose a port 650 on one side of the extracorporealapparatus which may be connect to an air pump. This port allows thesurgeon to position the extracorporeal apparatus 2 on the desired pointon the exterior of the patient's body. Then using the air pump, thesurgeon may pump air from beneath port 650, thereby decreasing thepressure between the extracorporeal apparatus 2 and the patient's body.The resulting pressure differential will gently lock the extracorporealapparatus in position on the patient's body. When the surgeon wishes toremove the apparatus, a release valve on the air pump may be opened,allowing normal pressure to return to the region between the apparatusand the patient's body, thus unlocking the apparatus.

The extracorporeal apparatus may also be anchored to the patient's bodyby use of a medical adhesive. A semi-permanent adhesive may be eitherplaced directly on the bottom surface 670 of the extracorporealapparatus 2, or alternatively, the adhesive may be placed around theedge of the extracorporeal apparatus as shown in FIG. 4D. The rim may bemoveable to align with the lower surface 670 of the extracorporealapparatus 2 when adhering to the patient's body, or retracted above thelower surface 670 of the extracorporeal apparatus when not adhering tothe patient's body.

In a standard laparoscopy for endometriosis, three ports are opened onthe patient's abdomen—the camera is placed through an umbilical port andtwo lower quadrant ports are used for instrumentation. Often, there isendometriosis deep in the pelvis or behind the ovary. In order to accessthe endometriosis and excise or fulgurate it, the surgeon must retractthe ovary through one port. The peritoneum must be tented up before theendometriosis can be excised or fulgurated in order to prevent damagingthe underlying structures.

With the present invention, the surgeon may start by placing the threeports: a camera in the umbilical port, and two operative ports in thelower quadrants. The surgeon then may engage a clamp intracorporealapparatus to a placement apparatus. Using one of the operative ports,the surgeon may feed the combination through the trocar into thepatient's body, and place the clamp on the ovary to be retracted. Thesurgeon then is able to place an extracorporeal apparatus on theexterior surface of the abdomen. The magnetic field attracts the clampand the surgeon is able to guide the ovary towards the extracorporealapparatus. The extracorporeal apparatus may be locked into positionusing an adhesive on the extracorporeal apparatus rim or an anchor. Withthe ovary now retracted against the abdominal wall and maintained by theextracorporeal apparatus, the surgeon is able to disengage the clampintracorporeal apparatus from the placement apparatus and retract theplacement apparatus back through the trocar and out of the patient'sbody. The ovary will now remain retracted against the interior surfaceof the anterior abdominal wall, well outside of the surgical field, andwithout the inclusion of a large intra-abdominal instrument.Accordingly, the surgeon will only need two intra-abdominal instruments,and may control all of the instruments in the operative field withoutassistance. This also beneficially results in less instrument clutter inthe operative field.

The present invention can also be very beneficial when performing alaparoscopic hysterectomy. In an open abdominal hysterectomy, a corkscrew is often placed in the fundus of the uterus and used for upwardtraction in order to decrease bleeding. The traction on the uterus alsomakes it much easier to access the lateral sides of the uterus andsuture and ligate the uterine arteries and cardinal ligaments. One ofthe difficulties in performing a laparoscopic hysterectomy is that thereis no way to retract the uterus in a similar fashion. It is oftendifficult to surgically place an extra port and use a grasper to retractthe uterus. The additional grasper often gets in the way of the otherintra-abdominal instruments, which are being used to carry out thedissection. Also, the surgeon is physically unable to manipulate morethan two instruments at a time. Lastly, a surgeon often experiencesdifficulty in trying to manipulate the uterus utilizing a grasper.

The present invention, allows the surgeon the ability to retract theuterus in the same fashion as if the surgeon were performing an openabdominal hysterectomy. Initially, the surgeon would engage a screwintracorporeal apparatus with a placement apparatus, and insert thecombination through a trocar into the patient's body. The surgeon isthen able to position the screw and twist it into the fundus of theuterus. An extracorporeal apparatus may then be placed on the externalanterior abdominal wall. The surgeon must choose an extracorporealapparatus with a magnet strong enough to attract the muscular andmassive uterus. The screw intracorporeal apparatus and the attacheduterus would then be attracted towards the magnetic field of theextracorporeal apparatus. Accordingly, the extracorporeal apparatuswould essentially provide upwards traction on the uterus similar to anopen abdominal case. Furthermore, the extracorporeal apparatus could bemoved laterally as needed to move the uterus and allow for easy accessto the lateral aspects of the uterus and cervix. With the screwintracorporeal apparatus attached to the uterus, the surgeon maydisengage and retract the placement apparatus through the trocar and outof the patient's body, thus freeing space within the body for otherintra-abdominal instruments.

The present invention can also be used to increase performance whenconducting a salpingectomy for a tubal ligation or an ectopic pregnancy.The current procedure is conducted with use of three ports: an umbilicalport for a camera, and two within which to operate. The procedurerequires a surgical assistant to grasp and hold the tube while thesurgeon performs the resection. However the present invention allows thesurgeon to perform the procedure without any assistance, and utilizingonly two ports: an umbilical port for the camera, and a superpubicoperative port. Initially, the surgeon would begin by engaging a clampintracorporeal apparatus to a placement apparatus, and passing thecombination through a trocar into the patient's body. At this point, thesurgeon can maneuver the clamp onto the area of the tube that is to beresected. An extracorporeal apparatus placed on the external abdominalwall could then be used to retract and grasp the tube. With the tuberetracted, the surgeon may disengage the placement apparatus and retractit through the trocar and out of the patient's body, thereby freeing upspace for a different intra-abdominal apparatus. Next, a harmonicscalpel or other such device would be used to resect the desired portionof the tube. Accordingly, the need for an extra port and a surgicalassistant is eliminated. Post-completion of the resection, the surgeonmay then reinsert the placement apparatus through the trocar into thepatient's body, and manipulate the clamp intracorporeal apparatus stillattached to the tube. The surgeon is able to then re-engage theplacement apparatus with the intracorporeal apparatus, and release theclamp from the tube. Finally, the surgeon may remove the resected tubefrom the abdominal cavity, retract the combination of the placementapparatus and the clamp through the trocar and seal the ports used inthe surgical procedure.

The present invention may also be used to help the surgeon avoid many ofthe common complications of laparoscopic surgery. A common complicationin laparoscopic surgery is ureteral damage. Ureteral damage, if notpromptly treated, may result in damage to renal function and possiblyloss of the kidney entirely. The present invention prevents damage to aureter by the insertion of an intracorporeal apparatus such as atoothless clamp or a loop to move a ureter away from the surgical field.

The present invention may also be used in general surgical procedures.For example, laparoscopic bariatric surgery can be made more efficientusing this invention. During a laparoscopic bariatric procedure, thesurgeon must retract the liver. Presently, this retractor requires theuse of an operative port. The present invention allows the surgeon theability to retract the liver without the use of a trocar-occupyinginstrument. Accordingly, the surgery could be performed with a reducednumber of ports and reduced intra-abdominal congestion.

The present invention may also be used in laparoscopic proceduresperformed on animals. For example, laparoscopic surgery routinelyperformed on baboons may be carried out more efficiently by means of thepresent invention. During diagnostic laparoscopic procedures, it hasbeen discovered that the uterus and ovaries of a baboon are more mobilethan those of humans. The present invention enables the surgeon toretract the uterus or ovaries of a baboon without the use of graspingforceps. This is preferable, because the use of grasping forceps hasbeen reported to result in slight round ligament bleeding in somelaparoscopic procedures performed on baboons. Laparoscopic surgery isalso performed on other animals, including mammals such as dogs, llamas,alpacas, mares, lions and cows. The present invention will enablesurgeons to accomplish such operations in a more efficient manner, as inhumans.

Numerous additional advantages may be realized by those having ordinaryskill in the art, for any situation in which a surgeon has thoroughknowledge of regional anatomy and requires moving internal objects ororgans so as to gain access to another object or organ in the body.

What is claimed is:
 1. A system for manipulating tissue inside a body ofa patient, comprising: an intracorporeal apparatus comprising a bodycomprising a first end comprising a clip, and a second end comprising amagnet or magnetically responsive material, wherein the second end isadapted to engage with a placement apparatus; and a placement apparatuscomprising: an elongated body comprising a proximal end and a distalend; a shaft disposed within the elongated body and comprising a shaftproximal end, and a shaft distal end adapted to selectively engage anddisengage the intracorporeal apparatus; and a handle located at theproximal end of the elongated body and operably connected to theproximal end of the shaft.
 2. The system of claim 1, wherein the secondend of the intracorporeal apparatus comprises a magnet.
 3. The system ofclaim 1, wherein the handle comprises a scissor-like mechanism.
 4. Thesystem of claim 1, wherein the second end of the intracorporealapparatus comprises magnetically responsive material.
 5. The system ofclaim 1, wherein the shaft distal end further comprises a magnet.
 6. Thesystem of claim 1, further comprising an extracorporeal apparatuscomprising a body and a source of magnetic energy configured to interactwith the intracorporeal apparatus.
 7. The system of claim 6, wherein thesource of magnetic energy is an electromagnet.
 8. The system of claim 6,wherein the extracorporeal apparatus further comprises a handle.
 9. Thesystem of claim 1, wherein the tissue comprises human tissue.
 10. Thesystem of claim 9, wherein the human tissue comprises a gall bladder.11. The system of claim 9, wherein the human tissue comprises tissueselected from the group consisting of an ovary, uterus, Fallopian tube,section of intestine, liver, and stomach.
 12. The system of claim 1,wherein the tissue comprises animal tissue.
 13. The system of claim 1,wherein the tissue comprises liver tissue.
 14. The system of claim 1,wherein the shaft distal end further comprises magnetically responsivematerial.